Yang J, Yang YX, Du QJ, Gao HW, Bai YN. Neutrophil-lymphocyte ratio, albumin-alkaline phosphatase ratio, and bilirubin predict outcomes in hepatectomy hepatolithiasis patients. World J Gastrointest Surg 2026; 18(1): 114810 [DOI: 10.4240/wjgs.v18.i1.114810]
Corresponding Author of This Article
Yong-Xin Yang, Laboratory Medicine Center, The Second Hospital & Clinical Medical School, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou 730000, Gansu Province, China. yangyongxinyy@163.com
Research Domain of This Article
Gastroenterology & Hepatology
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Retrospective Study
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This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Jan 27, 2026 (publication date) through Jan 28, 2026
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World Journal of Gastrointestinal Surgery
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1948-9366
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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA
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Yang J, Yang YX, Du QJ, Gao HW, Bai YN. Neutrophil-lymphocyte ratio, albumin-alkaline phosphatase ratio, and bilirubin predict outcomes in hepatectomy hepatolithiasis patients. World J Gastrointest Surg 2026; 18(1): 114810 [DOI: 10.4240/wjgs.v18.i1.114810]
World J Gastrointest Surg. Jan 27, 2026; 18(1): 114810 Published online Jan 27, 2026. doi: 10.4240/wjgs.v18.i1.114810
Neutrophil-lymphocyte ratio, albumin-alkaline phosphatase ratio, and bilirubin predict outcomes in hepatectomy hepatolithiasis patients
Jing Yang, Yong-Xin Yang, Qia-Jun Du, Hong-Wei Gao, Ya-Nan Bai
Jing Yang, Yong-Xin Yang, Qia-Jun Du, Hong-Wei Gao, Ya-Nan Bai, Laboratory Medicine Center, The Second Hospital & Clinical Medical School, Lanzhou University, Lanzhou 730000, Gansu Province, China
Author contributions: Yang J performed the majority of the experiments and wrote the manuscript; Yang YX designed the study and revised the manuscript; Du QJ was involved in analytical tools; Gao HW participated in sample collection; Bai YN served as a scientific advisor and participated in sample collection.
Institutional review board statement: This study was approved by the Medical Ethics Committee of the Second Hospital & Clinical Medical School, Lanzhou University, China, approval No. 2025A-246.
Informed consent statement: All patients provided informed consent.
Conflict-of-interest statement: No benefits in any form have been received or will be received from any commercial party directly or indirectly related to the subject of this article.
Data sharing statement: The technical appendix, statistical code, and dataset are available from the corresponding author.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Yong-Xin Yang, Laboratory Medicine Center, The Second Hospital & Clinical Medical School, Lanzhou University, No. 82 Cuiyingmen, Chengguan District, Lanzhou 730000, Gansu Province, China. yangyongxinyy@163.com
Received: September 28, 2025 Revised: October 25, 2025 Accepted: November 19, 2025 Published online: January 27, 2026 Processing time: 115 Days and 1.9 Hours
Abstract
BACKGROUND
Hepatolithiasis is a common disease whose key treatment modality is hepatectomy. However, postoperative complications are common and can adversely affect the therapeutic outcomes. The analysis of clinical data is essential to prevent a poor prognosis following hepatectomy.
AIM
To determine the prognostic value of the neutrophil-to-lymphocyte ratio (NLR), albumin/alkaline phosphatase ratio (ALB/ALP), and total bilirubin (TBIL) levels in hepatolithiasis hepatectomy.
METHODS
We retrospectively studied 135 patients with hepatolithiasis who underwent hepatectomy between March 2021 and August 2023. The patients were stratified into good and poor prognosis groups. We compared the general data and peripheral blood levels of NLR, ALB/ALP, and TBIL. Multivariate logistic regression was used to identify factors influencing poor prognosis, and the predictive value of these biomarkers was assessed using receiver operating characteristic (ROC) curve analysis.
RESULTS
Of 135 patients, 41 had poor prognosis. Comparative analysis revealed this group had significantly higher proportions of patients with an American Society of Anesthesiologists (ASA) score ≥ grade II, intraoperative blood transfusion, and a history of hepatobiliary surgery. These patients also had a lower anatomical hepatectomy rate and significantly greater intraoperative blood loss (P < 0.05). Biochemically, the poor prognosis group exhibited an elevated NLR and TBIL levels, along with a significantly reduced ALB/ALP (P < 0.05). Multivariate analysis confirmed ASA ≥ II, anatomical hepatectomy, blood loss, transfusion, and surgical history as independent factors for poor prognosis. Furthermore, ROC curve analysis established that NLR, ALB/ALP, and TBIL levels were valuable predictive biomarkers for post-hepatectomy prognosis in patients with hepatolithiasis, demonstrating high efficacy when combined.
CONCLUSION
The independent risk factors for poor post-hepatectomy prognosis were identified as ASA ≥ II, non-anatomical resection, high blood loss, transfusion, and prior surgery; NLR, ALB/ALP, and TBIL also held predictive value.
Core Tip: This study primarily compared the clinical data of patients with hepatolithiasis with good and poor prognoses following hepatectomy, analyzed the factors influencing poor prognosis, and identified scientific and reasonable indicators of poor prognosis. The novelty of this study lies in evaluating the peripheral blood levels of neutrophil-to-lymphocyte ratio (NLR), albumin/alkaline phosphatase ratio (ALB/ALP), and total bilirubin (TBIL) levels after hepatectomy and analyzing their individual and combined predictive values for poor prognosis. Notably, the NLR, ALB/ALP, and TBIL levels demonstrated predictive value for poor prognosis following hepatectomy, with high combined predictive efficiency.
